Weigh in on the Future of Managed Care in Wisconsin
Weigh in on the Future of Managed Care
in Wisconsin: Submit Comments byJuly 27
Why is this federal rule important?
The federal government has just issued some important rules that will shape how Wisconsins new managed care system the future Family Care and IRIS will operate in Wisconsin.
This rule is important in Wisconsin because the state is proposing to significantly change its managed care system - Family Care and IRIS. Wisconsin will soon allow private, for-profit companies to provide long-term services and supports and will include medical type services within the managed care system.
This rule will outline how managed care is run in the future in Wisconsin.
Submit Comments byJuly 27:
Advocates, participants and their families have untilJuly 27to provide comments on how these systems should work. Comments from individuals are essential as the insurance industry will also be weighing in. Every comment counts!
Whats in this rule?
ThisPowerPointoutlines key sections of the rule and gives ideas on comments you can make.
You can read the complete 653 page rule:here
An executive summary of five important areas for people with disabilities and their families to comment on is below.
1. Defining Home and Community Based Long-Term Services and Supports
- Many people with disabilities rely on Medicaid for more than just doctor visits. They also need personal care, transportation, meaningful activities during the day and community employment supports, among others.
- The rule is very focused on medical care and provides very few details on home and community based services.
2. Network Adequacy
- As with other parts of the rule, definitions about whether there are enough providers in an area are similar to those used in private health plans (medical healthcare) and are not specific to the types of community-based long-term services that people with disabilities need.
- The rule tells states to determine whether there are enough providers within a reasonable distance from you.
3. Stakeholder Involvement
- The rule indicates that stakeholders should be engaged, but it does not define what meaningful input looks likeincluding how many people, who is at the table, how often they should meet and what their roles should beor how stakeholders should be engaged.
4. Defining Profits and Administrative Costs
- The rule describes a standard called a medical loss ratio that outlines how much of insurers' revenue ends up going to the medical costs of patients versus administrative expenses and profits.
- The rule sets an 85% standard, meaning 85 % of insurers' revenue has to go to medical costs.
5. Monitoring Quality
- The rule requires managed care companies to use performance measures, monitor the quality of their long-term services and supports, and states that quality measures must include an effort to rebalance toward community integration.
- Ratings are based on indicators that are used in medical-type care and do not outline specifics for long-term services and supports. Long-term services and supports are very different from medical care supports. Many HMOs or MCOs lack experience serving people with more complex needs and those who self-direct their services. The rule does not specify any separate ranking system specific to long term care services.
***Thanks to the Wisconsin Board for People with Developmental Disabilities for sharing this information with us.
